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A comprehensive view of sex-specific issues related to cardiovascular disease

From the Divisions of Internal Medicine (Pilote, Dasgupta) and Clinical Epidemiology (Pilote, Dasgupta, Libersan), The McGill University Health Centre Research Institute, McGill University, Montréal, Que.; Division of Cardiovascular Surgery, Sunnybrook and Women's College Health Sciences Centre, Insititute for Clinical Evaluative Sciences (Guru), University of Toronto, Toronto, Ont.; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital (Humphries), University of British Columbia, Vancouver, BC; Department of Psychology (McGrath), Concordia University, Montréal, Que.; University of Alberta (Norris), Edmonton, Alta.; Faculty of Medicine, Department of Community Health Sciences (Rabi), Calgary, Alta.; Centre hospitalier de l'Université de Montréal Research Centre, Hôtel-Dieu (Tremblay, Hamet, Petrovich) and Groupe de recherche interdisciplinaire en santé, Département de médecine sociale et préventive (Barnett, O'Loughlin), University of Montreal, Montréal, Que.; Institut national de santé publique du Québec (Alamian, Paradis), Québec, Que.; New Halifax Infirmary Site, QEII Health Sciences Center (Cox), Dalhousie University, Halifax, NS; Department of Medicine and Community Health Sciences (Ghali), University of Calgary, Calgary, Alta.; York University (Grace), University Health Network, Toronto, Ont.; Department of Epidemiology and Biostatistics (Ho), McGill University, Montréal, Que.; Department of Community Health and Epidemiology (Kirkland), Dalhousie University, Halifax, NS; Département de pédiatrie (Lambert), Hôpital Ste-Justine and University of Montreal, Montréal, Que.; Centre for Clinical Epidemiology & Community Studies (Tagalakis), Jewish General Hospital-Sir Mortimer B. Davis, McGill University, Montréal, Que.

Correspondence to: Dr. Louise Pilote, The McGill University Health Centre Research Institute, Divisions of Internal Medicine and Clinical Epidemiology, 687 av. Des Pins Ouest, A4.23, Montréal QC H3A 1A1; fax 514 934-8293; louise.pilote{at}mcgill.ca

Abstract

Cardiovascular disease (CVD) is the leading cause of mortality in women. In fact, CVD is responsible for a third of all deaths of women worldwide and half of all deaths of women over 50 years of age in developing countries. The prevalence of CVD risk factor precursors is increasing in children. Retrospective analyses suggest that there are some clinically relevant differences between women and men in terms of prevalence, presentation, management and outcomes of the disease, but little is known about why CVD affects women and men differently. For instance, women with diabetes have a significantly higher CVD mortality rate than men with diabetes. Similarly, women with atrial fibrillation are at greater risk of stroke than men with atrial fibrillation. Historically, women have been underrepresented in clinical trials. The lack of good trial evidence concerning sex-specific outcomes has led to assumptions about CVD treatment in women, which in turn may have resulted in inadequate diagnoses and suboptimal management, greatly affecting outcomes. This knowledge gap may also explain why cardiovascular health in women is not improving as fast as that of men. Over the last decades, mortality rates in men have steadily declined, while those in women remained stable. It is also becoming increasingly evident that gender differences in cultural, behavioural, psychosocial and socioeconomic status are responsible, to various degrees, for the observed differences between women and men. However, the interaction between sex-and gender-related factors and CVD outcomes in women remains largely unknown.

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